- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.13 / $9,096.60 / $17,595.75
| Facility | | $6,916.13 | $9,096.60 | $17,595.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.09 / $1,301.83 / $9,696.00
| Facility | | $798.09 | $1,301.83 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,618.01 / $1,618.01 / $1,618.01
| Facility | AS | $1,618.01 | $1,618.01 | $1,618.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.58 / $1,902.37 / $5,718.15
| Facility | | $1,259.58 | $1,902.37 | $5,718.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |